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Sen H, Baydilli N, Ozturk M, Golbasi A, Seckiner İ, Demirci D. Factors effecting the success of retrograde intrarenal surgery in pediatric patients with renal stones: The experience of two tertiary centres with 368 renal units. J Pediatr Urol 2024; 20:403.e1-403.e9. [PMID: 38267307 DOI: 10.1016/j.jpurol.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/14/2023] [Accepted: 01/04/2024] [Indexed: 01/26/2024]
Abstract
INTRODUCTION AND OBJECTIVES Currently, in the field of pediatric urology, the primary aim of surgical approaches for the treatment of renal stone disease is to provide a stoneless state through minimally invasive methods, and to prevent the damage that such stones may cause in the urinary system and stone recurrence. The aim of this study was to evaluate the efficacy and safety of RIRS and the factors affecting its success in the surgical treatment of renal stones in pediatric patients. METHODS Data from 357 pediatric and 368 renal units were collected retrospectively. The recorded parameters were age, gender, location and burden of the stone, and presence of postoperative residual stones. RESULTS The stone location was the upper pole in 28 (7.6 %) patients, the middle pole in 44 (12 %), the pelvis in 98 (26.6 %), the lower pole in 139 (37.8 %), and multiple locations in 59 (16 %) patients. A stoneless state was achieved in 277 (75.3 %) units, while 91 units (24.7 %) had residual stones at the end of the first month. In the multivariate analysis, the development of residual stones was found to be significantly associated with age (odds ratio [OR], 1.123; p = 0.012) and stone location (OR, 3.142; p = 0.018). DISCUSSION RIRS is an endourological procedure with a high success rate in the achievement of a stoneless state in both pediatric and adult age groups, with an 82-100 % success rate reported in various studies. A full stoneless state was achieved in 277 (75.3 %) units after the initial RIRS in the present study, and full stone clearance was achieved in 304 units after the second RIRS session, with a success rate of 82.6 %. A limitation of our study is that it was not performed by a single surgeon, and stone samples could not be taken from all patients for stone analysis. CONCLUSION RIRS has also been associated with a high success rate in the endoscopic treatment of renal stones and is an efficient and safe method with a minimal rate of complications, especially in the pediatric age group.
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Affiliation(s)
- Haluk Sen
- University of Gaziantep, School of Medicine, Department of Urology, Turkey.
| | - Numan Baydilli
- University of Erciyes, School of Medicine, Department of Urology, Turkey.
| | - Mehmet Ozturk
- University of Gaziantep, School of Medicine, Department of Urology, Turkey.
| | - Abdullah Golbasi
- University of Erciyes, School of Medicine, Department of Urology, Turkey.
| | - İlker Seckiner
- University of Gaziantep, School of Medicine, Department of Urology, Turkey.
| | - Deniz Demirci
- University of Erciyes, School of Medicine, Department of Urology, Turkey.
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Lv D, Tang L, Chen Y, Wang R, Liu L, Jian N, Zhang T, Shen T. Knowledge, attitudes, and practices towards urinary system stones among the Chengdu population. Sci Rep 2024; 14:11303. [PMID: 38760386 PMCID: PMC11101414 DOI: 10.1038/s41598-024-60227-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/19/2024] [Indexed: 05/19/2024] Open
Abstract
This cross-sectional study aimed to explore the knowledge, attitudes, and practices (KAP) regarding urinary system stones among the general public in Chengdu, China. Conducted between January and June 2023, this research targeted individuals undergoing physical examinations at the Health Management Center of Sichuan Provincial People's Hospital. Structured questionnaires were administered to collect demographic information and assess KAP related to urinary system stones. Following meticulous scrutiny, 1014 valid questionnaires were retained for analysis. The computed scores for knowledge, attitude, and practice were 9.36 ± 4.23 (possible score range 0-17), 37.75 ± 7.20 (possible score range 11-55), and 30.77 ± 4.00 (possible score range 10-50), respectively. These outcomes suggested insufficient knowledge and moderately positive attitudes and practices among the participants. Structural Equation Modeling (SEM) analysis revealed a direct impact of knowledge on attitude (β = 0.967, P < 0.001), with attitude subsequently exerting a direct influence on practice (β = 0.167, P < 0.001). This indicated an indirect impact of knowledge on practice. Additionally, there was a direct effect of knowledge on practice (β = 0.167, P < 0.001). In conclusion, the general populace in Chengdu exhibited insufficient knowledge and moderate attitudes and practices concerning urinary stones. These findings underscore the imperative for targeted educational interventions aimed at enhancing public awareness and fostering positive attitudes and practices toward urinary stone prevention and management.
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Affiliation(s)
- Dong Lv
- Department of Urology, Deyang People's Hospital, 173 Section One North Taishan Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - Liangyou Tang
- Department of Urology, Deyang People's Hospital, 173 Section One North Taishan Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - Yongbo Chen
- Department of Urology, Deyang People's Hospital, 173 Section One North Taishan Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - Rui Wang
- Department of Urology, Deyang People's Hospital, 173 Section One North Taishan Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - Ling Liu
- Department of Urology, Deyang People's Hospital, 173 Section One North Taishan Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - Nenghong Jian
- Department of Urology, Deyang People's Hospital, 173 Section One North Taishan Road, Jingyang District, Deyang, 618000, Sichuan, China
| | - Ting Zhang
- Department of Health Management and Institute of Health Management, Sichuan Provincial People's Hospital, School of Medicine,, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Qingyang District, Chengdu, 610072, Sichuan, China.
| | - Taimin Shen
- Department of Health Management and Institute of Health Management, Sichuan Provincial People's Hospital, School of Medicine,, University of Electronic Science and Technology of China, 32 West Second Section, First Ring Road, Qingyang District, Chengdu, 610072, Sichuan, China.
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3
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Wu CHW, Badreddine J, Su E, Tay K, Lin HTC, Rhodes S, Schumacher F, Bodner D. Beyond the kidney: extra-renal manifestations of monogenic nephrolithiasis and their significance. Pediatr Nephrol 2024; 39:1429-1434. [PMID: 38057433 DOI: 10.1007/s00467-023-06242-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The objective of this study was to explore the frequency of occurrence of extra-renal manifestations associated with monogenic nephrolithiasis. METHODS A literature review was conducted to identify genes that are monogenic causes of nephrolithiasis. The Online Mendelian Inheritance in Man (OMIM) database was used to identify associated diseases and their properties. Disease phenotypes were ascertained using OMIM clinical synopses and sorted into 24 different phenotype categories as classified in OMIM. Disease phenotypes caused by the same gene were merged into a phenotypic profile of a gene (PPG) such that one PPG encompasses all related disease phenotypes for a specific gene. The total number of PPGs involving each phenotype category was measured, and the median phenotype category was determined. Phenotype categories were classified as overrepresented or underrepresented if the number of PPGs involving them was higher or lower than the median, respectively. Chi-square test was conducted to determine whether the number of PPGs affecting a given category significantly deviated from the median. RESULTS Fifty-five genes were identified as monogenic causes of nephrolithiasis. A total of six significantly overrepresented and three significantly underrepresented phenotype categories were identified (p < 0.05). Four phenotypic categories (growth, neurological, skeletal, and abdomen/gastrointestinal) are significantly overrepresented after Bonferroni correction for multiple comparisons (p < 0.002). Among all phenotypes, impaired growth is the most common manifestation. CONCLUSION Recognizing the extra-renal manifestations associated with monogenic causes of kidney stones is critical for earlier diagnosis and optimal care in patients.
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Affiliation(s)
- Chen-Han Wilfred Wu
- Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA.
| | - Jad Badreddine
- Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Ethan Su
- Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Kimberly Tay
- Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Hsin-Ti Cindy Lin
- Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Stephen Rhodes
- Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
| | - Fredrick Schumacher
- Department of Population and Quantitative Health Sciences, School of Medicine, Cleveland, OH, USA
| | - Donald Bodner
- Department of Urology, Case Western Reserve University School of Medicine and University Hospitals, 11100 Euclid Ave., Cleveland, OH, 44106, USA
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Gefen AM, Zaritsky JJ. Review of childhood genetic nephrolithiasis and nephrocalcinosis. Front Genet 2024; 15:1381174. [PMID: 38606357 PMCID: PMC11007102 DOI: 10.3389/fgene.2024.1381174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024] Open
Abstract
Nephrolithiasis (NL) is a common condition worldwide. The incidence of NL and nephrocalcinosis (NC) has been increasing, along with their associated morbidity and economic burden. The etiology of NL and NC is multifactorial and includes both environmental components and genetic components, with multiple studies showing high heritability. Causative gene variants have been detected in up to 32% of children with NL and NC. Children with NL and NC are genotypically heterogenous, but often phenotypically relatively homogenous, and there are subsequently little data on the predictors of genetic childhood NL and NC. Most genetic diseases associated with NL and NC are secondary to hypercalciuria, including those secondary to hypercalcemia, renal phosphate wasting, renal magnesium wasting, distal renal tubular acidosis (RTA), proximal tubulopathies, mixed or variable tubulopathies, Bartter syndrome, hyperaldosteronism and pseudohyperaldosteronism, and hyperparathyroidism and hypoparathyroidism. The remaining minority of genetic diseases associated with NL and NC are secondary to hyperoxaluria, cystinuria, hyperuricosuria, xanthinuria, other metabolic disorders, and multifactorial etiologies. Genome-wide association studies (GWAS) in adults have identified multiple polygenic traits associated with NL and NC, often involving genes that are involved in calcium, phosphorus, magnesium, and vitamin D homeostasis. Compared to adults, there is a relative paucity of studies in children with NL and NC. This review aims to focus on the genetic component of NL and NC in children.
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Affiliation(s)
- Ashley M. Gefen
- Phoenix Children’s Hospital, Department of Pediatrics, Division of Nephrology, Phoenix, AZ, United States
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Chait AR, Hassig S, Cubillos J, Jain R, Quarrier SO. Cystinuria Complicated by Anuria From Bilateral Obstructing Stones Requiring Bilateral Mini Percutaneous Nephrolithotomy in a 22-Month-Old. Urology 2024; 185:88-90. [PMID: 38281667 DOI: 10.1016/j.urology.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/31/2023] [Indexed: 01/30/2024]
Abstract
Pediatric nephrolithiasis is increasing in incidence and presents differently compared to adults. We report a case of nephrolithiasis in a pediatric patient, presenting with complaints of emesis, anuria, hematuria, and abdominal distension, leading to a diagnosis of bilateral obstructing cystine stones requiring bilateral percutaneous nephrolithotomy. Pediatric patients with anuria should be evaluated for bilateral nephrolithiasis as an etiology. Calculous anuria requires prompt recognition of the pathologic process and relief of the obstruction with close follow-up and supportive care until definitive stone management. Bilateral percutaneous nephrolithotomy can provide definitive surgical intervention without significant morbidity.
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Affiliation(s)
- Alexander R Chait
- Department of Urology, University of Rochester Medical Center, Rochester, NY.
| | - Stephen Hassig
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Jimena Cubillos
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Rajat Jain
- Department of Urology, University of Rochester Medical Center, Rochester, NY
| | - Scott O Quarrier
- Department of Urology, University of Rochester Medical Center, Rochester, NY
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Kamal W, Azhar RA, Hamri SB, Alathal AH, Alamri A, Alzahrani T, Abeery H, Noureldin YA, Alomar M, Al Own A, Alnazari MM, Alharthi M, Awad MA, Halawani A, Althubiany HH, Alruwaily A, Violette P. The Saudi urological association guidelines on urolithiasis. Urol Ann 2024; 16:1-27. [PMID: 38415236 PMCID: PMC10896325 DOI: 10.4103/ua.ua_120_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/29/2024] Open
Abstract
Aims The Saudi Urolithiasis Guidelines are a set of recommendations for diagnosing, evaluating, and treating urolithiasis in the Saudi population. These guidelines are based on the latest evidence and expert consensus to improve patient outcomes and optimize care delivery. They cover the various aspects of urolithiasis, including risk factors, diagnosis, medical and surgical treatments, and prevention strategies. By following these guidelines, health-care professionals can improve care quality for individuals with urolithiasis in Saudi Arabia. Panel The Saudi Urolithiasis Guidelines Panel consists of urologists specialized in endourology with expertise in urolithiasis and consultation with a guideline methodologist. All panelists involved in this document have submitted statements disclosing any potential conflicts of interest. Methods The Saudi Guidelines on Urolithiasis were developed by relying primarily on established international guidelines to adopt or adapt the most appropriate guidance for the Saudi context. When necessary, the panel modified the phrasing of recommendations from different sources to ensure consistency within the document. To address areas less well covered in existing guidelines, the panel conducted a directed literature search for high quality evidence published in English, including meta analyses, randomized controlled trials, and prospective nonrandomized comparative studies. The panel also searched for locally relevant studies containing information unique to the Saudi Arabian population. The recommendations are formulated with a direction and strength of recommendation based on GRADE terminology and interpretation while relying on existing summaries of evidence from the existing guidelines.
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Affiliation(s)
- Wissam Kamal
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
| | - Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abdulaziz H Alathal
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz Alamri
- Surgery Department, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Tarek Alzahrani
- Dr. Sulaiman Al Habib Hospital (Swaidi), Riyadh, Saudi Arabia
| | | | - Yasser A Noureldin
- Division of Urology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Urology, Faculty of Medicine, Benha University, Egypt
- Department of Clinical Sciences, Northern Ontario School of Medicine, ON, Canada
| | - Mohammad Alomar
- Department of Urology, King Fahad Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mansour M Alnazari
- Department of Urology, College of Medicine, Taibah university, Madinah, Saudi Arabia
| | - Majid Alharthi
- Department of Urology, King Fahad General Hospital, Jeddah, Saudi Arabia
- Seoul National University Hospital, Seoul, South Korea
| | - Mohannad A Awad
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
- Department of Urology, University of Texas Southwestern Medical Southwestern Medical Centre, Dallas, TX, USA
| | - Abdulghafour Halawani
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatem Hamed Althubiany
- Department of Urology, Imam Abdulrahman Bin Faisal University, Dammam King Fahd Hospital of the University, Dammam, Saudi Arabia
| | | | - Phillipe Violette
- Woodstock General Hospital, London Ontario, Canada
- McMaster University, London Ontario, Canada
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7
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Lasorsa F, Caliolo C, Silecchia A, Laricchiuta N, Raguso M, Ditonno P, Lucarelli G. Management of Pediatric Urolithiasis in an Italian Tertiary Referral Center: A Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2165. [PMID: 38138268 PMCID: PMC10745114 DOI: 10.3390/medicina59122165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: In recent years, the prevalence of pediatric urolithiasis has increased in North America and Western countries, though it is endemic in developing countries. The aim of this study is to describe the experience of a tertiary pediatric referral center in the surgical management of pediatric urolithiasis. Materials and Methods: We retrospectively reviewed the experience of patients ≤ 16 years old affected by urinary stones who underwent surgery. Results: From April 2021 to September 2023, 31 pediatric patients underwent surgical procedures for stone diseases at our department: 13 preschool-aged (1-5 years) and 18 school-aged (6-16 years) children. During this period, 12 URSs, 17 RIRSs, and 2 PCNLs were recorded. Five patients had residual fragments at first, so three of them underwent a second endourological lithotripsy (2 RIRSs and 1 URS). Complete clearance was finally achieved in 27 patients. The stone composition was evaluated in 25 cases. Conclusions: Numerous innovations in the surgical treatment of pediatric urolithiasis have resulted from the development of smaller devices and new technology. Our results show how, in experienced centers, retrograde and percutaneous lithotripsy are safe and effective procedures for use in pediatric populations.
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Affiliation(s)
- Francesco Lasorsa
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Claudia Caliolo
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Antonia Silecchia
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Nicola Laricchiuta
- Urologic Pediatric Surgery Unit, Pediatric Hospital “Giovanni XXIII”, 70124 Bari, Italy
| | - Michele Raguso
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Pasquale Ditonno
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Giuseppe Lucarelli
- Department of Precision and Regenerative Medicine and Ionian Area-Urology, Andrology and Kidney Transplantation Unit, University of Bari “Aldo Moro”, 70124 Bari, Italy
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Lumbreras J, Madariaga L, Rodrigo MD. Pediatric renal lithiasis in Spain: research, diagnostic and therapeutic challenges, and perspectives. Front Pediatr 2023; 11:1294319. [PMID: 38143536 PMCID: PMC10746353 DOI: 10.3389/fped.2023.1294319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/20/2023] [Indexed: 12/26/2023] Open
Abstract
Incidence and prevalence of urolithiasis is apparently increasing worldwide, also among children and adolescents. Nevertheless, robust data have only been obtained in a few countries. In Spain, a voluntary Registry for Pediatric Renal Lithiasis has been active since 2015. Irregular participation limits its applicability, as well as its limitation to patients with a stone available for morphocompositional study, to obtain data about incidence and prevalence. On the other hand, findings about typology of stones and clinical and analytical characteristics of these subjects have been communicated in several meetings. Other valuable efforts in this field are the elaboration of guidelines for the collection and processing of urine samples for the study of urolithiasis in pediatric patients with the consensus of the Spanish Society for Pediatric Nephrology (AENP) as well as the Spanish Society for Laboratory Medicine (SEQC), the collaborative network RenalTube for the diagnosis of primary tubulopathies and the registry of patients with Primary Hyperoxaluria (OxalSpain). In many hospitals from the public healthcare system, pediatric nephrologists are the specialists in charge of the management of children with kidney stones, but there is no formal regulation on this competence. Other specialists, such as urologists, pediatric surgeons or pediatric urologists, in many cases do not offer a complete insight into the etiopathogenic mechanisms and the consequent medical treatment. Access to medication according to standards of treatment is warranted, provided a correct diagnosis is achieved, but criteria for the reimbursement of certain therapies, such as RNAi drugs for primary hyperoxaluria, are arguable.
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Affiliation(s)
- Javier Lumbreras
- Pediatric Nephrology Unit, Department of Pediatrics, Son Espases University Hospital, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Leire Madariaga
- Pediatric Nephrology Department, Cruces University Hospital, IIS Biocruces Bizkaia, University of the Basque Country, CIBERER/CIBERDEM/EndoERN, Barakaldo, Spain
| | - María Dolores Rodrigo
- Pediatric Nephrology Unit, Department of Pediatrics, Son Espases University Hospital, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
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9
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Gefen AM, Sethna CB, Cil O, Perwad F, Schoettler M, Michael M, Angelo JR, Safdar A, Amlie-Wolf L, Hunley TE, Ellison JS, Feig D, Zaritsky J. Genetic testing in children with nephrolithiasis and nephrocalcinosis. Pediatr Nephrol 2023; 38:2615-2622. [PMID: 36688940 PMCID: PMC11071637 DOI: 10.1007/s00467-023-05879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
BACKGROUND Diagnosing genetic kidney disease has become more accessible with low-cost, rapid genetic testing. The study objectives were to determine genetic testing diagnostic yield and examine predictors of genetic diagnosis in children with nephrolithiasis/nephrocalcinosis (NL/NC). METHODS This retrospective multicenter cross-sectional study was conducted on children ≤ 21 years old with NL/NC from pediatric nephrology/urology centers that underwent the Invitae Nephrolithiasis Panel 1/1/2019-9/30/2021. The diagnostic yield of the genetic panel was calculated. Bivariate and multiple logistic regression were performed to assess for predictors of positive genetic testing. RESULTS One hundred and thirteen children (83 NL, 30 NC) from 7 centers were included. Genetic testing was positive in 32% overall (29% NL, 40% NC) with definite diagnoses (had pathogenic variants alone) made in 11.5%, probable diagnoses (carried a combination of pathogenic variants and variants of uncertain significance (VUS) in the same gene) made in 5.4%, and possible diagnoses (had VUS alone) made in 15.0%. Variants were found in 28 genes (most commonly HOGA1 in NL, SLC34A3 in NC) and 20 different conditions were identified. Compared to NL, those with NC were younger and had a higher proportion with developmental delay, hypercalcemia, low serum bicarbonate, hypophosphatemia, and chronic kidney disease. In multivariate analysis, low serum bicarbonate was associated with increased odds of genetic diagnosis (β 2.2, OR 8.7, 95% CI 1.4-54.7, p = 0.02). CONCLUSIONS Genetic testing was high-yield with definite, probable, or possible explanatory variants found in up to one-third of children with NL/NC and shows promise to improve clinical practice. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Ashley M Gefen
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 269-01 76th Ave, Queens, NY, 11040, USA.
| | - Christine B Sethna
- Division of Nephrology, Department of Pediatrics, Cohen Children's Medical Center, 269-01 76th Ave, Queens, NY, 11040, USA
| | - Onur Cil
- Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Farzana Perwad
- Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Megan Schoettler
- Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Mini Michael
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Joseph R Angelo
- Division of Nephrology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX, USA
| | - Adnan Safdar
- Division of Nephrology, Department of Pediatrics, Tawam Hospital, Al Ain, United Arab Emirates
| | - Louise Amlie-Wolf
- Precision Medicine/Genetic Testing Stewardship Program, Nemours Children's Health, Delaware Valley, Wilmington, DE, USA
| | - Tracy E Hunley
- Division of Nephrology, Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Jonathan S Ellison
- Division of Pediatric Urology, Department of Urology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Daniel Feig
- Division of Nephrology, Department of Pediatrics, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Joshua Zaritsky
- Division of Nephrology, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, USA
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Yang H, Qi L, Zhou J, Li Q, Yuan X, Zhang M, He Y, Huang K, Chen P. Metal ions-regulated chemical vapor generation of Hg 2+:mechanism and application in miniaturized point discharge atomic emission spectrometry assay of oxalate in clinical urolithiasis samples. Anal Chim Acta 2023; 1262:341223. [PMID: 37179054 DOI: 10.1016/j.aca.2023.341223] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/03/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
It is well known that the coexisting metal ions could significantly influence the atomic spectroscopy (AS) analysis. In this work, a cation-modulated mercury ions (Hg2+) strategy via chemical vapor generation (CVG) was developed for oxalate assay due to the phenomenon that the Ag + can significantly reduce the Hg2+ signal. The regulation effect was studied in depth via experimental investigations. Since Ag + can be reduced to silver nanoparticles (Ag NPs) by reductant SnCl2, the decrease of the Hg2+ signal is attributed to the formation of a silver-mercury (Ag-Hg) amalgam. Due to the oxalate can react with Ag + to generate Ag2C2O4, which can reduce the generation of Ag-Hg amalgam, a portable and low-power point discharge chemical vapor generation atomic emission spectrometry (PD-CVG-AES) system was constructed to quantify the content of oxalate via monitoring the signal of Hg2+. Under optimal conditions, the limit of detection (LOD) was as low as 40 nM in the range of 0.1-10 μM for oxalate assay, while exhibiting good specificity. This method was applied to quantitative oxalate in 50 clinical urine samples of urinary stones patients. The levels of oxalate detected in clinical samples were consistent with clinical imaging results, which is promising for point-of-care testing in clinical diagnosis.
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Affiliation(s)
- Haiyan Yang
- College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Liping Qi
- College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Jinrong Zhou
- College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Qian Li
- College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China
| | - Xin Yuan
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Mei Zhang
- College of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, 611137, China
| | - Yong He
- Department of Laboratory Medicine, Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Ke Huang
- College of Chemistry and Material Science, Sichuan Normal University, Chengdu, Sichuan, 610068, China; Key Laboratory of Land Resources Evaluation and Monitoring in Southwest, Ministry of Education, Sichuan Normal University, Chengdu, 610068, China.
| | - Piaopiao Chen
- Department of Laboratory Medicine, Med+X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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11
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Woźniak MM, Mitek-Palusińska J. Imaging urolithiasis: complications and interventions in children. Pediatr Radiol 2023; 53:706-713. [PMID: 36576514 PMCID: PMC10027801 DOI: 10.1007/s00247-022-05558-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/26/2022] [Accepted: 11/30/2022] [Indexed: 12/29/2022]
Abstract
Urolithiasis affects people in all age groups, but over the last decades there has been an increasing incidence in children. Typical symptoms include abdominal or flank pain with haematuria; in acute cases dysuria, fever or vomiting also occur. Ultrasound is considered the modality of choice in paediatric urolithiasis because it can be used to identify most clinically relevant stones. Complementary imaging modalities such as conventional radiographs or non-contrast computed tomography should be limited to specific clinical situations. Management of kidney stones includes dietary, pharmacological and urological interventions, depending on stone size, location or type, and the child's condition. With a very high incidence of underlying metabolic abnormalities and significant recurrence rates in paediatric urolithiasis, thorough metabolic evaluation and follow-up examination studies are of utmost importance.
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Affiliation(s)
- Magdalena Maria Woźniak
- Department of Pediatric Radiology, Medical University of Lublin, Al. Racławickie 1, 20-059, Lublin, Poland.
| | - Joanna Mitek-Palusińska
- Department of Pediatric Radiology, Medical University of Lublin, Al. Racławickie 1, 20-059, Lublin, Poland
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12
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Bernardor J, Bidault V, Bacchetta J, Cabet S. Pediatric urolithiasis: what can pediatricians expect from radiologists? Pediatr Radiol 2023; 53:695-705. [PMID: 36329164 DOI: 10.1007/s00247-022-05541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
The incidence of urolithiasis in children has increased over the two last decades. Urolithiasis formation results from urine oversaturation following insufficient water intake, urinary obstruction (notably in cases of congenital uropathies), excess production of an insoluble compound, or imbalance between crystallization promoters and inhibitors. Whereas most urolithiases in adults occur secondary to environmental factors, in children, secondary causes are far more frequent, and 15% are related to genetic causes, most often monogenic. This is especially true in recurrent forms, with early and rapid progression and bilateral stones, and in cases of familial history or consanguinity. Because of differing clinical management, one should rule out cystinuria, primary hyperoxaluria and renal tubular acidosis, among other causes of urolithiasis. As such, a complete biochemical evaluation must be performed in all cases of pediatric urolithiasis, even in cases of an underlying uropathy. Ultrasound examination is the first-line modality for imaging pediatric urolithiasis, allowing both diagnosis (urolithiasis and its complications) and follow-up. US examination should also explore clues to an underlying cause of urolithiasis. This review is focused on the role of imaging in the management and etiological assessment of pediatric urolithiasis. Radiologists play an important role in pediatric urolithiasis, facilitating diagnosis, follow-up and surgical management. A trio of clinicians (pediatric nephrologist, pediatric surgeon, pediatric radiologist) is thus necessary in the care of these pediatric patients.
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Affiliation(s)
- Julie Bernardor
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Centre de Référence des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID et ERKNet, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
- Institut National de la Santé et de la Recherche Médicale, Lyon, France.
- Service de Néphrologie Pédiatrique, Centre Hospitalo-Universitaire de Nice, Hôpital Archet, Nice, France.
- Faculté de Médecine, Université Côte d'Azur, Nice, France.
| | - Valeska Bidault
- Service de Chirurgie Pédiatrique, Hôpital Bicêtre, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Justine Bacchetta
- Centre de Référence des Maladies Rares du Calcium et du Phosphore, Centre de Référence des Maladies Rénales Rares, Filières de Santé Maladies Rares OSCAR, ORKID et ERKNet, Service de Néphrologie Rhumatologie et Dermatologie Pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Institut National de la Santé et de la Recherche Médicale, Lyon, France
- Faculté de Médecine Lyon Est, Université de Lyon, Lyon, France
| | - Sara Cabet
- Service d'imagerie Pédiatrique et Foetale, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Physiopathologie et Génétique du Neurone et du Muscle, Institut NeuroMyoGène, Université de Lyon, Lyon, France
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13
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Md Sabudin SNS, Yaacob LH, Draman N. An atypical presentation of urolithiasis with pyonephrosis in a child: A case report. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
<b>Background:</b> Childhood urolithiasis is previously rare but increasingly recognized nowadays. Presentation varies, and often children, do not present with the classical symptoms commonly seen in adults.<br />
<b>Case report:</b> This case was initially presented to the emergency department with atypical symptoms of nephrolithiasis. Therefore, he was treated for acute appendicitis before an ultrasound abdomen revealed there is gross hydronephrosis, which is secondary to pelvic-ureteric junction obstruction. CT abdomen was then proceeded, found right nephrolithiasis and vesicoureteric calculus with right hydroureter and gross hydronephrosis. Retrograde pyelography (RPG), ureteroscopy (URS), and insertion of the stent for right pelvic-ureteric junction obstruction were performed and subsequently, he developed complications.<br />
<b>Conclusion: </b>The initial presentation of this case is common however not a classical presentation of renal stone. Therefore, evaluation of the symptoms and initial investigations should be done properly, so that we will not miss this common disease with the rare presentation, especially in children.
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Affiliation(s)
- Siti Nur Syakinah Md Sabudin
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Lili Husniati Yaacob
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
| | - Nani Draman
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
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14
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Pediatric Nephrolithiasis. Healthcare (Basel) 2023; 11:healthcare11040552. [PMID: 36833086 PMCID: PMC9957182 DOI: 10.3390/healthcare11040552] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
The prevalence of pediatric nephrolithiasis has increased dramatically in the past two decades for reasons that have yet to be fully elucidated. Workup of pediatric kidney stones should include metabolic assessment to identify and address any risk factors predisposing patients to recurrent stone formation, and treatment should aim to facilitate stone clearance while minimizing complications, radiation and anesthetic exposure, and other risks. Treatment methods include observation and supportive therapy, medical expulsive therapy, and surgical intervention, with choice of treatment method determined by clinicians' assessments of stone size, location, anatomic factors, comorbidities, other risk factors, and preferences and goals of patients and their families. Much of the current research into nephrolithiasis is restricted to adult populations, and more data are needed to better understand many aspects of the epidemiology and treatment of pediatric kidney stones.
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15
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Chen J, Ho DS, Xiang G, Sankin G, Preminger GM, Lipkin ME, Zhong P. Cavitation Plays a Vital Role in Stone Dusting During Short Pulse Holmium:YAG Laser Lithotripsy. J Endourol 2022; 36:674-683. [PMID: 34806899 PMCID: PMC9145256 DOI: 10.1089/end.2021.0526] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective: To investigate the mechanism of stone dusting in Holmium (Ho): YAG laser lithotripsy (LL). Materials and Methods: Cylindrical BegoStone samples (6 × 6 mm, H × D) were treated in water using a clinical Ho:YAG laser lithotripter in dusting mode (0.2-0.4 J with 70-78 μs in pulse duration, 20 Hz) at various fiber tip to stone standoff distances (SD = 0, 0.5, and 1 mm). Stone damage craters were quantified by optical coherence tomography and bubble dynamics were captured by high-speed video imaging. To differentiate the contribution of cavitation vs thermal ablation to stone damage, three additional experiments were performed. First, presoaked wet stones were treated in air to assess stone damage without cavitation. Second, the laser fiber was advanced at various offset distances (OSD = 0.25, 1, 2, 3, and 10 mm) from the tip of a flexible ureteroscope to alter the dynamics of bubble collapse. Third, stones were treated with parallel fiber to minimize photothermal damage while isolating the contribution of cavitation to stone damage. Results: Treatment in water resulted in 2.5- to 90-fold increase in stone damage compared with those produced in air where thermal ablation dominates. With the fiber tip placed at OSD = 0.25 mm, the collapse of the bubble was distracted away from the stone surface by the ureteroscope tip, leading to significantly reduced stone damage compared with treatment without the scope or with scope at large OSD of 3-10 mm. The average crater volume produced by parallel fiber orientation at 0.2 J after 100 pulses, where cavitation is the dominant mechanism of stone damage, was comparable with those produced by using perpendicular fiber orientation within SD = 0.25-1 mm. Conclusion: Cavitation plays a dominant role over photothermal ablation in stone dusting during short pulse Ho:YAG LL when 10 or more pulses are delivered to the same location.
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Affiliation(s)
- Junqin Chen
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Derek S. Ho
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Gaoming Xiang
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Georgy Sankin
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Glenn M. Preminger
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Michael E. Lipkin
- Division of Urology, Duke University Medical Center, Durham, North Carolina, USA
| | - Pei Zhong
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.,Address correspondence to: Pei Zhong, PhD, Department of Mechanical Engineering and Materials Science, Duke University, Box 90300, Durham, NC 27708, USA
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16
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Comparison of infants and children with urolithiasis: a large case series. Urolithiasis 2022; 50:411-421. [PMID: 35482085 DOI: 10.1007/s00240-022-01327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/10/2022] [Indexed: 10/18/2022]
Abstract
We evaluated the demographic features, etiologic risk factors, treatment strategies, and outcome of the infants and children with urolithiasis (UL). A retrospective multicenter study was conducted including 23 Pediatric Nephrology centers in Turkey. The medical records of 2513 children with UL were reviewed. One thousand, three hundred and four boys and 1209 girls (1.1:1) were reported. The mean age at diagnosis was 39.5 ± 35 months (0.4-231 months), and 1262 patients (50.2%) were in the first year of life (infants). Most of the cases with infantile UL were diagnosed incidentally. Microlithiasis (< 3 mm) was found in 794 patients (31.6%), and 64.5% of the patients with microlithiasis were infants. Stones were located in the pelvis-calyces in 63.2% (n: 1530) of the cases. The most common stone type was calcium oxalate (64.6%). Hypocitraturia was the most common metabolic risk factor (MRF) in children older than 12 months, but in infancy, hypercalciuria was more common. Fifty-five percent of the patients had received at least one medical treatment, mostly potassium citrate. At the end of a year's follow-up, most of the patients with microlithiasis (85%) showed spontaneous remission. The rate of spontaneous stone resolution in infants was higher than in children. Spontaneous remission rate was higher in cases with MRF ( - ) stones than in MRF ( +) stones. However, remission rate with medical treatment was higher in cases with MRF ( +) stones. This study represents the results of a large series of infants and children with UL and showed that there are several differences such as underlying metabolic and anatomic abnormalities, clinical course, and stone remission rates between infants and children with urinary stone disease.
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17
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Eslahi A, Hosseini MM, Ahmed F, Tanaomi D, Hosseini SH, Askarpour MR, Nikbakht HA, Al-Naggar K. Totally ultrasound-guided minimally invasive percutaneous nephrolithotomy in children: Is it safe? Afr J Paediatr Surg 2022; 19:68-72. [PMID: 35017374 PMCID: PMC8809463 DOI: 10.4103/ajps.ajps_13_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The objective of the study was to assess the outcome and feasibility of ultrasonography (US)-guided minimally invasive percutaneous nephrolithotomy (mini-PCNL) in children. MATERIALS AND METHODS Twenty-five children with upper urinary tract stones who had undergone US-guided mini-PCNL from June 2017 to June 2020 were enrolled in this study. Patients' demographic information and post-treatment results were retrospectively gathered and analysed. Pyelocaliceal system was punctured in prone position using US guidance, and the tract was dilated using single-shot dilation technique. All steps of renal access were done using only US. Mini-PCNL in all cases was done by using 15 Fr rigid nephroscope. Stones were fragmented with a pneumatic lithotripter and evacuated. RESULTS The patients' mean age was 6.30 ± 3.25 years (range: 1.5-15). The mean stone size was 16.04 ± 3.93 mm (range: 10-30). The mean access time to the stone was 1.50 ± 0.62 min (range: 1-4). The mean operation time was 94.66 ± 3.05 min (range: 90-100 min). The final stone-free rate was 96%. Post-operation fever occurred in 4 (16%) patients who were treated successfully with an antibiotic. No major complications occurred. CONCLUSIONS We recommend US-guided mini-PCNL as a harmless alternative treatment option, in children with renal calculi due to its excellent outcomes and little complications.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences; Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mehdi Hosseini
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faisal Ahmed
- Department of Urology, Urology Research Center, Al-Thora Hospital, Ibb University of Medical Since, Ibb, Yemen
| | - Delara Tanaomi
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Hossein Hosseini
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Askarpour
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein-Ali Nikbakht
- Department of Biostatics and Epidemiology, Social Determinates of Health Research Center, Faculty of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Khalil Al-Naggar
- Department of Urology, Urology Research Center, Al-Thora Hospital, Ibb University of Medical Since, Ibb, Yemen
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18
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Wang X, Zhang Y, Zhao F, Li J, Yian Y. Symptomatic recurrence rate of upper urinary tract calculi in children after endourological procedures. J Pediatr Urol 2022; 18:141.e1-141.e7. [PMID: 35300915 DOI: 10.1016/j.jpurol.2021.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The recurrence rate of paediatric urolithiasis was less reported, especially in Asians. Our aim was to verify the symptomatic recurrence rate of Chinese paediatric urolithiasis and to determine the predictive factors for stone recurrence. MATERIALS AND METHODS We performed a retrospective review of children who presented with first upper urinary tract calculi from June 2014 to September 2019. For the follow-up, we generated Kaplan-Meier plots with time to stone recurrence and Cox proportional hazard regression analyses were applied. The recurrence was defined as a new symptomatic stone on ultrasound and/or computerized tomography. RESULTS A total of 230 children with a median age of 5 yr (IQR 4-8) were included. Calcium oxalate was found in 72% of stones, and calcium apatite was found in 32% of stones. After a median follow-up of 39.5 months, 34 (14.8%) children had stone recurrence. Median time to stone recurrence was 31 months. Among them, 31 (91.2%) required surgical intervention. Older children (P < 0.01), higher BMI (HBM) (P < 0.01) and higher stone burden (P < 0.01) were shown to be associated with stone recurrence in the univariate analysis. The multivariate Cox regression analysis showed that children with stone burden > 2 cm3 had a higher risk of recurrence (HR 4.84, 95%CI 2.28-10.3). Children with HBM had an increased recurrence rate compared to normal BMI children (HR 2.99, 95%CI 1.36-6.56). CONCLUSIONS The symptomatic recurrence rate of paediatric urolithiasis in Chinese is not as high as that reported in Caucasians. HBM and higher stone burden are associated with higher recurrence rates.
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Affiliation(s)
- Xiaochuan Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China.
| | - Yu Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China.
| | - Fangzhou Zhao
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China.
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China.
| | - Ye Yian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, People's Republic of China.
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19
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Zheng J, Zhang Y, Rasheed H, Walker V, Sugawara Y, Li J, Leng Y, Elsworth B, Wootton RE, Fang S, Yang Q, Burgess S, Haycock PC, Borges MC, Cho Y, Carnegie R, Howell A, Robinson J, Thomas LF, Brumpton BM, Hveem K, Hallan S, Franceschini N, Morris AP, Köttgen A, Pattaro C, Wuttke M, Yamamoto M, Kashihara N, Akiyama M, Kanai M, Matsuda K, Kamatani Y, Okada Y, Walters R, Millwood IY, Chen Z, Davey Smith G, Barbour S, Yu C, Åsvold BO, Zhang H, Gaunt TR. Trans-ethnic Mendelian-randomization study reveals causal relationships between cardiometabolic factors and chronic kidney disease. Int J Epidemiol 2022; 50:1995-2010. [PMID: 34999880 PMCID: PMC8743120 DOI: 10.1093/ije/dyab203] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 09/01/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study was to systematically test whether previously reported risk factors for chronic kidney disease (CKD) are causally related to CKD in European and East Asian ancestries using Mendelian randomization. METHODS A total of 45 risk factors with genetic data in European ancestry and 17 risk factors in East Asian participants were identified as exposures from PubMed. We defined the CKD by clinical diagnosis or by estimated glomerular filtration rate of <60 ml/min/1.73 m2. Ultimately, 51 672 CKD cases and 958 102 controls of European ancestry from CKDGen, UK Biobank and HUNT, and 13 093 CKD cases and 238 118 controls of East Asian ancestry from Biobank Japan, China Kadoorie Biobank and Japan-Kidney-Biobank/ToMMo were included. RESULTS Eight risk factors showed reliable evidence of causal effects on CKD in Europeans, including genetically predicted body mass index (BMI), hypertension, systolic blood pressure, high-density lipoprotein cholesterol, apolipoprotein A-I, lipoprotein(a), type 2 diabetes (T2D) and nephrolithiasis. In East Asians, BMI, T2D and nephrolithiasis showed evidence of causality on CKD. In two independent replication analyses, we observed that increased hypertension risk showed reliable evidence of a causal effect on increasing CKD risk in Europeans but in contrast showed a null effect in East Asians. Although liability to T2D showed consistent effects on CKD, the effects of glycaemic phenotypes on CKD were weak. Non-linear Mendelian randomization indicated a threshold relationship between genetically predicted BMI and CKD, with increased risk at BMI of >25 kg/m2. CONCLUSIONS Eight cardiometabolic risk factors showed causal effects on CKD in Europeans and three of them showed causality in East Asians, providing insights into the design of future interventions to reduce the burden of CKD.
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Affiliation(s)
- Jie Zheng
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Yuemiao Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, P. R. China
| | - Humaira Rasheed
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Venexia Walker
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yuka Sugawara
- Division of Nephrology and Endocrinology, The University of Tokyo Hospital, Tokyo, Japan
| | - Jiachen Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, P. R. China
| | - Yue Leng
- Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Benjamin Elsworth
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Robyn E Wootton
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Si Fang
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Qian Yang
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Stephen Burgess
- MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Philip C Haycock
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Maria Carolina Borges
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Yoonsu Cho
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Rebecca Carnegie
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Amy Howell
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Jamie Robinson
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
| | - Laurent F Thomas
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ben Michael Brumpton
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Thoracic Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristian Hveem
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stein Hallan
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Nephrology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Nora Franceschini
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Andrew P Morris
- Division of Musculoskeletal and Dermatological Sciences, University of Manchester, Manchester, UK
| | - Anna Köttgen
- Institute of Genetic Epidemiology, Department of Biometry, Epidemiology and Medical Bioinformatics, Faculty of Medicine and Medical Center–University of Freiburg, Freiburg, Germany
| | - Cristian Pattaro
- Eurac Research, Institute for Biomedicine (affiliated with the University of Lübeck), Bolzano, Italy
| | - Matthias Wuttke
- Institute of Genetic Epidemiology, Department of Biometry, Epidemiology and Medical Bioinformatics, Faculty of Medicine and Medical Center–University of Freiburg, Freiburg, Germany
| | - Masayuki Yamamoto
- Tohoku Medical Megabank Organization and Tohoku University Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Naoki Kashihara
- Department of Nephrology and Hypertension, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Masato Akiyama
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Department of Ophthalmology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Kanai
- Department of Biomedical Informatics, Harvard Medical School, Boston, MA, USA
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koichi Matsuda
- Department of Computational Biology and Medical Sciences, Graduate school of Frontier Sciences, the University of Tokyo, Tokyo, Japan
| | - Yoichiro Kamatani
- Laboratory for Statistical Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
- Laboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, the University of Tokyo, Tokyo, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
| | - Robin Walters
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Iona Y Millwood
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK
| | - Sean Barbour
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Provincial Renal Agency, Vancouver, British Columbia, Canada
| | - Canqing Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, P. R. China
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hong Zhang
- Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, P. R. China
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, UK
- NIHR Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK
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20
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A case of early onset cystinuria in a 4-month-old girl. CEN Case Rep 2021; 11:216-219. [PMID: 34669168 DOI: 10.1007/s13730-021-00655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
Cystinuria is an autosomal recessive disorder characterized by a decrease in the reabsorption of cystine and dibasic amino acids (lysine, ornithine, and arginine) in the renal proximal tubule. It presents with recurrent urolithiasis. Cystinuria accounts for 6-8% of all pediatric urolithiasis. The age of onset is typically 10-30 years. Here, we report a case of early-onset cystinuria. A 4-month-old girl presented with hematuria. We noticed multiple renal calculi in ultrasonography and abdominal computerized tomography scans. The diagnosis was cystinuria with urinary calculus analysis and urinary amino acid analysis. The patient was treated with urine alkalinization and cystine chelating drugs. Gene analysis showed a P482L heterozygous mutation from her mother, and an A70V heterozygous mutation from her father, in the SLC7A9 gene. This gene encodes a putative subunit of the neutral and basic amino acid transport protein, BAT1. Although cystinuria is an autosomal recessive disease, there have been previous reports of P482L heterozygous mutations greatly suppressing cystine reabsorption and causing cystinuria symptoms. Therefore, the highly influential P482L mutation of the SLC7A9 gene may have contributed to the onset of this autosomal recessive disease at an extremely young age.
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21
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Alam R, Matlaga BR, Alam A, Winoker JS. Contemporary considerations in the management and treatment of lower pole stones. Int Braz J Urol 2021; 47:957-968. [PMID: 33861542 PMCID: PMC8321457 DOI: 10.1590/s1677-5538.ibju.2021.0010] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 01/05/2021] [Indexed: 12/23/2022] Open
Abstract
The presence of lower pole stones poses a unique challenge due to the anatomical considerations involved in their management and treatment. Considerable research has been performed to determine the optimal strategy when faced with this highly relevant clinical scenario. Standard options for management include observation, shock wave lithotripsy, retrograde intrarenal surgery, or percutaneous nephrolithotomy. Indeed, each approach confers a distinct set of risks and benefits, which must be placed into the context of patient preference and expected outcomes. The current state of practice reflects a combination of lessons learned from managing calculi not only in the lower pole, but also from other locations within the kidney as well.
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Affiliation(s)
- Ridwan Alam
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brian R Matlaga
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ayman Alam
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jared S Winoker
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, USA
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22
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Eslahi A, Ahmed F, Hosseini MM, Rezaeimehr MR, Fathi N, Nikbakht HA, Askarpour MR, Hosseini SH, Al-Naggar K. Minimal invasive percutaneous nephrolithotomy (Mini-PCNL) in children: Ultrasound versus fluoroscopic guidance. ACTA ACUST UNITED AC 2021; 93:173-177. [PMID: 34286551 DOI: 10.4081/aiua.2021.2.173] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/13/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Miniaturization of endoscopic instruments in percutaneous nephrolithotomy (PCNL) allowed less invasive procedures with low complication rates, especially in children. This study was conducted to evaluate the safety and efficacy of ultrasonography-guided (USG) versus fluoroscopy-guided (FG) mini-PCNL in children. MATERIALS AND METHODS This is a retrospective comparative study conducted from June 2015 to June 2020. The sample included 70 children (35 pateints underwent USG mini-PCNL and 35 pateints underwent FG mini-PCNL). They were compared mainly by the patients' demographic characteristics, procedural information, and post-treatment outcomes. In the USG mini-PCNL group, puncturing was performed using a 3.5 MHz US probe, whereas fluoroscopy was utilized in the FG mini- PCNL group. RESULTS Both groups were comparable in terms of gender, previous history of failed ESWL, and hydronephrosis grade. The mean stone burden was 15.94 ± 3.69 mm and 19.20 ± 7.41 mm in USG and FG groups, respectively (p = 0.024). The stonefree rate (SFR) was 97.1% in the USG group and 94.3% in the FG group, which was not statistically significant (p = 0.16). Mean operative time in the USG group and FG group was 69.00 ± 13.33 minutes and 63.48 ± 16.90 minutes, respectively. Four (11.4%) patients in the FG group required blood transfusions to restore the hemodynamic state (p = 0.039). Fever was detected in 4 (11.4%) patients in the USG group and 15 (31.4%) patients in the FG group (p = 0.041). CONCLUSIONS In children, mini PCNL under USG is safe and as effective as fluoroscopy.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, School of medicine, Shiraz University of Medical Sciences, Shiraz; Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz.
| | - Faisal Ahmed
- Urology research center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Since, Ibb.
| | | | | | - Nazanin Fathi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz.
| | - Hossein-Ali Nikbakht
- Social Determinates of Health Research Center, Department of Biostatics and Epidemiology, Faculty of Medicine, Babol University of Medical Sciences, Babol.
| | | | - Seyed Hossein Hosseini
- Department of Urology, School of medicine, Shiraz University of Medical Sciences, Shiraz.
| | - Khalil Al-Naggar
- Urology research center, Al-Thora General Hospital, Department of Urology, Ibb University of Medical Since, Ibb.
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23
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Hosseini MM, Irani D, Altofeyli A, Eslahi A, Basiratnia M, Haghpanah A, Adib A, Ahmed F. Outcome of Mini-Percutaneous Nephrolithotomy in Patients Under the Age of 18: An Experience With 112 Cases. Front Surg 2021; 8:613812. [PMID: 34211997 PMCID: PMC8239139 DOI: 10.3389/fsurg.2021.613812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: Renal calculi are becoming more common among children. Although, extracorporeal shock wave lithotripsy (ESWL) is the first choice in this age group, minimal invasive surgeries, such as percutaneous nephrolithotomy (PCNL), are indicated for some patients. Recently, PCNL devices have become smaller in size with acceptable efficacy and lower complications. We evaluated the outcomes and complications of mini-PCNL (MPCNL) surgery in our referral training centers. Materials and Methods: Between September 2012 and January 2020, a total of 112 children under the age of 18, who had shown failure of ESWL, and/or their parents refused to do it, underwent MPCNL (15 Fr). The patients' profiles were reviewed for data collection including preoperative and stone data, operation information, and postoperative complications. Results: Of 112 patients, 69 were boys, and 43 were girls. Their mean age was 8.6 years (14 months to 18 years). Mean stone size was 20 mm (14–34 mm). Seventy-four cases had renal pelvic stone, 22 had pelvis and lower pole, and 16 had staghorn. The mean operation time was 65 min (35–100 min), and mean radiation time was 0.6 min (0.2–1.4 min). Low-grade fever was detected in 14 patients (12.5%). Four patients needed blood transfusion and two had increased creatinine, which improved with conservative management. One patient developed urosepsis that resolved with antibiotic therapy. None of the patients had kidney perforation or other organ injury or death. Early stone-free rate (SFR) after operation was 90.2% (101 patients). Six patients had residual fragment <5 mm, which passed spontaneously in 2 weeks after operation (total SFR 95.3%). Three patients underwent second-look nephroscopy, and ureteroscopy was done for two patients due to migrated stone fragments to the distal ureter. Conclusion: MPCNL is recommended as a safe alternative option for treatment of the nephrolithiasis in children with good outcome and acceptable complications.
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Affiliation(s)
- Mohammad Mehdi Hosseini
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dariush Irani
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ala'a Altofeyli
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Eslahi
- Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mitra Basiratnia
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdolreza Haghpanah
- Department of Urology, Shaheed Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Adib
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Faisal Ahmed
- Department of Urology, Urology Research Center, Al-Thora General Hospital, Ibb University of Medical Since, Ibb, Yemen
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24
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Epidemiologie. Urolithiasis 2021. [DOI: 10.1007/978-3-662-62454-8_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Hameed BMZ, S. Dhavileswarapu AVL, Naik N, Karimi H, Hegde P, Rai BP, Somani BK. Big Data Analytics in urology: the story so far and the road ahead. Ther Adv Urol 2021; 13:1756287221998134. [PMID: 33747134 PMCID: PMC7940776 DOI: 10.1177/1756287221998134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 12/25/2022] Open
Abstract
Artificial intelligence (AI) has a proven record of application in the field of medicine and is used in various urological conditions such as oncology, urolithiasis, paediatric urology, urogynaecology, infertility and reconstruction. Data is the driving force of AI and the past decades have undoubtedly witnessed an upsurge in healthcare data. Urology is a specialty that has always been at the forefront of innovation and research and has rapidly embraced technologies to improve patient outcomes and experience. Advancements made in Big Data Analytics raised the expectations about the future of urology. This review aims to investigate the role of big data and its blend with AI for trends and use in urology. We explore the different sources of big data in urology and explicate their current and future applications. A positive trend has been exhibited by the advent and implementation of AI in urology with data available from several databases. The extensive use of big data for the diagnosis and treatment of urological disorders is still in its early stage and under validation. In future however, big data will no doubt play a major role in the management of urological conditions.
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Affiliation(s)
- B. M. Zeeshan Hameed
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India KMC Innovation Centre, Manipal Academy of Higher Education, Manipal, India iTRUE (International Training and Research in Uro-Oncology and Endourology) Group
| | | | - Nithesh Naik
- Department of Mechanical and Manufacturing Engineering, Faculty of Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India
- iTRUE (International Training and Research in Uro-Oncology and Endourology) Group
| | - Hadis Karimi
- Department of Pharmacy, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Padmaraj Hegde
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Bhavan Prasad Rai
- iTRUE (International Training and Research in Uro-Oncology and Endourology) Group Department of Urology, Freeman Hospital, Newcastle, UK
| | - Bhaskar K. Somani
- Department of Urology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, India
- iTRUE (International Training and Research in Uro-oncology and Endourology) Group Department of Urology, University Hospital Southampton NHS Trust, Southampton, UK
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26
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Ralph D, Allawh R, Terry IF, Terry SF, Uitto J, Li Q. Kidney Stones are Prevalent in Individuals with Pseudoxanthoma Elasticum, a Genetic Ectopic Mineralization Disorder. INTERNATIONAL JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2020; 3:198-204. [PMID: 34925949 PMCID: PMC8680818 DOI: 10.1097/jd9.0000000000000126] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Pseudoxanthoma elasticum (PXE) is a rare genetic disorder caused by loss-of-function mutations in the ABCC6 gene. While PXE is characterized by ectopic mineralization of connective tissues clinically affecting the skin, eyes, and cardiovascular system, kidney stones were reported in some individuals with PXE. The aim of this study is to determine whether kidney stones are an incidental finding or a frequent manifestation of PXE. We investigated the genetic basis of two siblings diagnosed with PXE. The younger patient presented with recurrent kidney stones since age 8. To address whether kidney stones are associated with PXE, the prevalence of kidney stones in a survey cohort of 563 respondents with PXE was compared to that of a general U.S. population survey, NHANES (National Health and Nutrition Examination Survey), with 28,629 participants. Genetic analysis in both patients identified compound heterozygous mutations in ABCC6, c.2787+1G>T and c.3774_3775insC. The analysis of participants aged 20 and older revealed that 23.4% of PXE patients had previously had a kidney stone, a significant increase compared to 9.2% in the general population. In addition, 17.8% of PXE patients reported their first kidney stone episode before age 18. PXE correlates with an increased risk of developing kidney stones with considerable morbidity and health-care cost.
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Affiliation(s)
- Douglas Ralph
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Rina Allawh
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ian F. Terry
- PXE International, Inc., Washington, DC 20008, USA
| | | | - Jouni Uitto
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Qiaoli Li
- Department of Dermatology and Cutaneous Biology, The Sidney Kimmel Medical College, and The PXE International Center of Excellence in Research and Clinical Care, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
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27
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Zhang Y, Wang X, Li J, Yian Y. Influence of Body Mass Index on the Surgical Outcomes of Flexible Ureteroscopy for Pediatric Upper Urinary Tract Aalculi-A Single Surgeon Experience. Urology 2020; 153:291-297. [PMID: 33227303 DOI: 10.1016/j.urology.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the association between body mass index (BMI) and surgical outcomes of flexible ureteroscopy (FURS) for pediatric upper urinary tract calculi and to estimate the influence of BMI percentile on the learning curve of pediatric FURS. MATERIALS AND METHODS We reviewed our prospectively maintained database containing children who had kidney or ureteral stones from June 2014 to April 2019. We calculated BMI and plotted it on the Centers for Disease Control and Prevention growth chart for sex and age to estimate BMI percentile. Patient demographics, intraoperative data, stone characteristics, stone-free rate (SFR), and complication rate (CR) were analyzed. Learning curves stratified by BMI percentile groups were generated. RESULTS The final analysis included 161 children, of whom 63 (39.1%) had upper body weight percentile (UBW), 64 (39.8%) had normal body weight percentile (NBW), and 34 (21.1%) had lower body weight percentile (LBW). The median stone burden of the 3 groups were 1.14 (IQR 0.50-3.41), 1.13 (IQR 0.70-3.14), and 0.95 (IQR 0.50-1.77), respectively (P = .17). The SFRs were 90.5% (57/63) in the UBW group, 81.2% (52/64) in the NBW group and 70.6% (24/34) in the LBW group (P = .04). The CRs were 15.9% (10/63), 21.9% (14/64), and 29.4% (10/34), respectively (P = .29). The learning curves showed that the SFR of FURS could be improved after about 100 cases. And decreasing BMI could steepen the learning curve of SFR. CONCLUSIONS BMI is associated with the SFR of FURS. LBW children had the lowest SFR compared to UBW and NBW children. Lower BMI percentile makes the success of FURS more challenging.
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Affiliation(s)
- Yu Zhang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - XiaoChuan Wang
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Jun Li
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ye Yian
- Department of Urology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
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28
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Larson NP, Bridwell RE, Yoo MJ. A Tale From the Early Stone Age: Pediatric Ureterolithiasis as Appendicitis Mimic - A Case Report and Management Overview. Cureus 2020; 12:e10637. [PMID: 33123450 PMCID: PMC7584291 DOI: 10.7759/cureus.10637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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29
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Kallash M, Rheault MN. Approach to Persistent Microscopic Hematuria in Children. KIDNEY360 2020; 1:1014-1020. [PMID: 35369549 PMCID: PMC8815596 DOI: 10.34067/kid.0003222020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 07/10/2020] [Indexed: 06/14/2023]
Abstract
Persistent isolated microscopic hematuria is relatively common in pediatric practice, affecting around 0.25% of children. Isolated microscopic hematuria can be caused by a myriad of potentially benign or serious causes, including urologic issues; kidney stones; glomerular diseases, including disorders of the glomerular basement membrane; hematologic abnormalities; and others. The challenge for the pediatrician or pediatric nephrologist is to distinguish children with potentially progressive forms of kidney disease versus other causes while minimizing cost and inconvenience for the child and family. This manuscript will review the multiple potential causes of microscopic hematuria and provide a framework for the initial evaluation and monitoring of such patients.
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Affiliation(s)
- Mahmoud Kallash
- Division of Pediatric Nephrology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Michelle N. Rheault
- Division of Pediatric Nephrology, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
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30
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Koo K, Aro T, Becker RE, Lim S, Winoker JS, Petrisor D, Stoianovici D, Matlaga BR. Integrated Real-Time Digital Measurement During Ureteroscopic Procedures for Nephrolithiasis: A Workflow Feasibility Study. J Endourol 2020; 34:900-904. [DOI: 10.1089/end.2020.0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Kevin Koo
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tareq Aro
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Russell E.N. Becker
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sunghwan Lim
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jared S. Winoker
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Doru Petrisor
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dan Stoianovici
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Robotics Laboratory, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Brian R. Matlaga
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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31
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Ang AJS, Sharma AA, Sharma A. Nephrolithiasis: Approach to Diagnosis and Management. Indian J Pediatr 2020; 87:716-725. [PMID: 32794099 DOI: 10.1007/s12098-020-03424-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 06/17/2020] [Indexed: 02/06/2023]
Abstract
Although kidney stones are less common in children than in adults, incidence in children is rising. Kidney stones may lead to significant morbidity in addition to escalating medical costs. Clinical presentation is variable. Bilateral kidney stones in a younger child should prompt work-up for primary hyperoxaluria. Metabolic abnormalities are more frequent in children and can result in frequent stone recurrence. Whole exome sequencing data shows genetic defects in about 30% of stone formers. 24 h urine collection should be conducted when patient receives his usual diet and fluid intake with normal activity. Infrared spectroscopy and X-ray diffraction are used for stone analysis. Urine studies should be delayed by 4-6 wk after stone fragmentation or treatment of any stone related complications. The goal of evaluation is to identify modifiable risk factors for which targeted therapy may be instituted. Primary indications for surgical intervention include pain, infection and obstruction. Extracorporeal shockwave lithotripsy (ESWL), ureteroscopy, and percutaneous nephrolithotomy (PCNL) are most commonly used, and selection is based on stone size, anatomy, composition and anatomy. Advances in technology have allowed a shift to minimally invasive surgeries. Comprehensive management requires multidisciplinary team. Children with kidney stones require long term follow-up with periodic assessment of stone forming activity and ascertaining stone burden. High index of suspicion should be there to diagnose diseases like primary hyperoxaluria, Dent's disease, renal tubular acidosis (RTA) etc. as these diseases have ramifications on kidney function and growth.
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Affiliation(s)
| | | | - Amita Sharma
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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33
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Cochran D, Cook G, Rensing A, Frimberger D, Meenakshi-Sundaram B. A Rare Case of T-Cell Lymphoma Presenting With Bilateral Nephrolithiasis and Acute Renal Failure. Urology 2020; 146:222-224. [PMID: 32592766 DOI: 10.1016/j.urology.2020.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/09/2020] [Accepted: 06/13/2020] [Indexed: 11/17/2022]
Abstract
We present the rare case of a young boy who was found to have T-cell lymphoma after presenting with flank pain and bilateral nephrolithiasis. He initially underwent bilateral ureteral stent placement but returned with oliguria and acute renal failure. His subsequent workup revealed lymphoma involving both kidneys. He was started on chemotherapy for his lymphoma and dialysis for his renal failure. His stones ultimately dissolved with aggressive hydration and correction of serum uric acid levels. In this report, we discuss the identification and management of this rare condition.
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Affiliation(s)
- David Cochran
- Department of Urology, University of Oklahoma HSC, Children's Hospital at OU Medical Center, Oklahoma City, OK
| | - Gates Cook
- Department of Urology, University of Oklahoma HSC, Children's Hospital at OU Medical Center, Oklahoma City, OK
| | - Adam Rensing
- Department of Urology, University of Oklahoma HSC, Children's Hospital at OU Medical Center, Oklahoma City, OK
| | - Dominic Frimberger
- Department of Urology, University of Oklahoma HSC, Children's Hospital at OU Medical Center, Oklahoma City, OK
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Denburg MR, Koepsell K, Lee JJ, Gerber J, Bittinger K, Tasian GE. Perturbations of the Gut Microbiome and Metabolome in Children with Calcium Oxalate Kidney Stone Disease. J Am Soc Nephrol 2020; 31:1358-1369. [PMID: 32381601 DOI: 10.1681/asn.2019101131] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/22/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The relationship between the composition and function of gut microbial communities and early-onset calcium oxalate kidney stone disease is unknown. METHODS We conducted a case-control study of 88 individuals aged 4-18 years, which included 44 individuals with kidney stones containing ≥50% calcium oxalate and 44 controls matched for age, sex, and race. Shotgun metagenomic sequencing and untargeted metabolomics were performed on stool samples. RESULTS Participants who were kidney stone formers had a significantly less diverse gut microbiome compared with controls. Among bacterial taxa with a prevalence >0.1%, 31 taxa were less abundant among individuals with nephrolithiasis. These included seven taxa that produce butyrate and three taxa that degrade oxalate. The lower abundance of these bacteria was reflected in decreased abundance of the gene encoding butyryl-coA dehydrogenase (P=0.02). The relative abundance of these bacteria was correlated with the levels of 18 fecal metabolites, and levels of these metabolites differed in individuals with kidney stones compared with controls. The oxalate-degrading bacterial taxa identified as decreased in those who were kidney stone formers were components of a larger abundance correlation network that included Eggerthella lenta and several Lactobacillus species. The microbial (α) diversity was associated with age of stone onset, first decreasing and then increasing with age. For the individuals who were stone formers, we found the lowest α diversity among individuals who first formed stones at age 9-14 years, whereas controls displayed no age-related differences in diversity. CONCLUSIONS Loss of gut bacteria, particularly loss of those that produce butyrate and degrade oxalate, associates with perturbations of the metabolome that may be upstream determinants of early-onset calcium oxalate kidney stone disease.
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Affiliation(s)
- Michelle R Denburg
- Division of Nephrology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen Koepsell
- Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jung-Jin Lee
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jeffrey Gerber
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle Bittinger
- Division of Gastroenterology, Department of Pediatrics, Hepatology, and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania .,Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Pediatric Urology, Department of Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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